Paying for prescription drugs - Insurance Commissioner Office of the Washington State
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Paying for
prescription
drugs
The Statewide Health Insurance Benefits Advisors (SHIBA)
program is a free, unbiased service sponsored by:
Washington State
Office of the
Insurance CommissionerThis booklet is designed to help you make informed decisions about your health coverage. It offers information about various prescription drug programs and plans, such as Medicare, individual health insurance plans, prescription discount cards, disease- and disability-related programs, free and low-cost programs, public health programs, buying online, and more. Please note, we do not endorse any particular option, nor does the appearance of a company or website constitute an endorsement of its policies. We do our best to provide consumers with up-to-date information. Information printed in this publication was current at the time of printing. Due to constant changes in the health arena, you may find some website addresses and phone numbers have changed. If you would like to discuss the information in this publication along with your options, please make an appointment to talk with one of our Statewide Health Insurance Benefits Advisors (SHIBA). The service is free. Our volunteer advisors can help you understand your rights and options. Call our Insurance Consumer Hotline at 1-800-562-6900 and ask to speak with a SHIBA advisor in the county where you live. Paying for prescription drugs
Table of Contents
Programs for Medicare enrollees 1
Insurance coverage 2
Insurance plans 2
Drug discount cards 3
Disease- and disability-related programs 4
Free or low-cost programs 7
Charity programs 8
Community social service agency programs 9
Clinical drug trials 9
Comparison shopping 9
Buying from Canada 9
Canadian Internet/mail order 10
Cautions for buying prescriptions online 10
Paying for prescription drugsPrograms for Medicare enrollees
Medicare prescription drug coverage (Part D) is available to everyone with Medicare. The open
enrollment period for all Part D enrollees and Medicare Advantage plan occurs each year from
Oct. 15 through Dec. 7. Those new to Medicare Parts A and B will receive their own initial
enrollment period for Part D.
Please note: If you qualify for the low-income subsidy (also called Extra Help) with Medicare’s
prescription drug coverage, you can apply year-round.
All Medicare clients qualify for prescription drug coverage (Part D). Enrollment is voluntary.
You have the option to get Part D coverage through a stand-alone Medicare Part D plan or
through a Medicare Advantage plan.
If you already have prescription drug coverage, ask your plan if it’s as good as Part D. If it is, you
can delay signing up for Part D with no penalty. You may want to research your options before
taking any action.
For help understanding your options, call our Insurance Consumer Hotline at 1-800-562-
6900 and ask to speak with a SHIBA volunteer advisor or go to: www.insurance.wa.gov.
Your other option is to contact the Centers for Medicare and Medicaid Services (CMS) at
1-800-MEDICARE (1-800-633-4227) or www.medicare.gov.
Medicare clients
If you have a Medicare Advantage or a Medigap (Medicare Supplement) plan, but
no prescription drug coverage, SHIBA can help you! To find out your options and
see if you qualify for programs to help pay for your prescriptions, call our Insurance
Consumer Hotline at 1-800-562-6900 and ask to speak with a SHIBA volunteer advisor.
Another option is to contact the Centers for Medicare and Medicaid Services at
1-800-MEDICARE (1-800-633-4227) or at www.medicare.gov.
1 Paying for prescription drugsInsurance coverage
Many insurance plans pay all or part of the cost of prescription drugs. If you have or qualify for
one of the plans listed on pages 2-3, study the benefits carefully. Check to see what percentage of
the costs you’ll have to pay, and if there’s a maximum amount you (or the plan) will pay per year
(or per lifetime).
Also, ask for a copy of the formulary (a list of covered drugs) to see if your prescriptions are on
it, and if you must substitute a generic drug, if one is available. You might also want to find out
if the plan requires you to use certain pharmacies and specifies how you get your prescriptions
(i.e., through mail order).
Insurance plans
Department of Veterans Affairs Administration (may help with Rx costs for qualified
veterans)
Phone: 1-877-222-VETS (8387)
Website: www.va.gov/health
TRICARE Pharmacy Program
Phone: 1-877-363-1303
Website: tricare.mil/mybenefit/ or www.express-scripts.com/TRICARE/
Washington Apple Health
This program, which includes prescription drug coverage, merged Apple Health for Kids and
Medicaid into one program that serves people of all ages who qualify. Note: Medicaid programs
for seniors, and the blind and disabled should apply through: www.washingtonconnection.org
Phone: 1-855-923-4633
To apply online: www.wahealthplanfinder.org
For more information: www.hca.wa.gov
Washington Healthplanfinder
Under health reform, if you buy an individual health plan through the health insurance
Exchange, you may qualify for help paying your premium. These plans include prescription
drug coverage.
Phone: 1-855-923-4633
Website: www.wahealthplanfinder.org
Washington State Health Insurance Pool (WSHIP)
Phone: 1-800-877-5187
Website: www.wship.org
Paying for prescription drugs 2For the following insurance plans, check your benefits booklet or your plan’s website for more
information, or call the phone number listed on your plan’s insurance card:
• Employer plans (these include the Washington State Public Employees Benefit Board
and the Federal Employees Health Plan)
• Individual insurance (comprehensive and catastrophic)
• Medicare Advantage or Medicare Health plans (some of these offer prescription drug
coverage)
Drug discount cards
There are hundreds of prescription drug discount cards available that provide you with
discounts on certain medications covered under the card. Some cards are free, while others
charge a fee. You can also join buyers’ clubs for a fee. However, before you pay any fee, check
to see what discounts they offer on the prescription drugs you take, whether they work at your
preferred pharmacy, and if they specify how you get your prescriptions (i.e., through mail order).
AAA Prescription Savings Card is available to AAA members. This free discount card can
save you an average of 20 - 24 percent at participating pharmacies.
Phone: 1-800-562-2582
Website: www.aaawa.com/discounts
Free Drug Card US can save you up to 75 percent at more than 54,000 national and regional
pharmacies.
Phone: 1-877-321-6755
Website: www.freedrugcard.us
National Association of Counties Prescription Drug Discount Card Program (NACo)
is a free discount card. NACo distributes the card in some Washington state counties that you
can use nationwide. Discounts average 20 percent and most pharmacies will honor it. There’s no
application process. You can also use this card for your pet’s prescriptions. Call or go online to
find out which counties distribute the card and where to get one.
Phone: 1-877-321-2652
Website: www.nacorx.org
Pequot Pharmaceutical Network
Phone: 1-800-342-5779
Website: www.prxn.com
3 Paying for prescription drugsRX Saver may help people save an average of 20 percent at over 60,000 pharmacies nationwide.
Phone: 1-800-800-1626
Website: www.rx-saver.com
Rx Savings Plus is a free discount card that can help you save an average of 22 percent on
regular retail prices at over 65,000 participating pharmacies.
Phone: 1-877-673-3688
Website: www.rxsavingsplus.com
Washington Prescription Drug Program (WPDP), formerly Rx Washington, allows you to
save up to 60 percent on generic prescription drugs, and up to 20 percent on brand name drugs.
All Washington state resident of any age or income qualify. The WPDP card is not a Medicare
Part D prescription drug plan. However, the card may provide discounts on medicines not
covered by Medicare or other health insurance plans.
Phone: 1-800-913-4146
Website: www.hca.wa.gov/pdp/Pages/discountcard.aspx
Disease- and disability-related programs
Some disease-specific support groups also offer drug funding help to people in need. These
support groups include:
Administration on Aging (AoA) offers resources and information.
Website: www.aoa.gov
American Cancer Society has local chapters that sometimes offer funds to help with
prescription and care costs. They also may know about local programs that are free or low cost.
Phone: 1-800-227-2345
Website: www.cancer.org
American Epilepsy Society offers information for doctors and patients about drug company
programs that help with epilepsy medications.
Website: www.aesnet.org
Assistance Fund may help patients with health insurance who cannot afford the copay for
specialty medications.
Phone: 1-855-845-3663
Website: www.theassistancefund.org
Paying for prescription drugs 4Breast and Cervical Health Program (BCHP) offers free, early detection screenings for
breast, cervical and colon cancer to low-income people in Washington state. This program is
run by the Washington State Department of Health.
Phone: 1-888-438-2247
Website: www.doh.wa.gov/YouandYourFamily/IllnessandDisease/Cancer/
BreastCervicalandColonHealth.aspx
End Stage Renal Disease (ESRD) or kidney failure qualifies people for Medicare even if they
are under age 65. If you have ESRD and have Medicare, there are rules about what kind of
Medicare plans you can be on. For more information, check out:
Centers for Medicare and Medicaid Services offers the booklet “Medicare Coverage
of Kidney Dialysis and Kidney Transplant Services.” You can also ask for a comparison of
dialysis facilities in your area.
Medicare also offers an online comparison tool to evaluate Medicare Prescription Drug
plans and Medicare Advantage plans in your area.
Phone: 1-800-MEDICARE (1-800-633-4227)
TTY: 1-877-486-2048
Website: www.Medicare.gov
Statewide Health Insurance Benefits Advisors (SHIBA)
Phone: 1-800-562-6900 to speak with a SHIBA volunteer advisor
Website: www.insurance.wa.gov
Washington State Kidney Disease Program (KDP) is a state-funded program that helps
low-income, eligible people with treatment costs for End-Stage Renal Disease (ESRD). Each
contracted kidney center determines client eligibility. Eligibility is based on the KDP’s
residential and medical criteria, and income and asset standards.
Website: www.hca.wa.gov/medicaid/rbrvs/pages/kidneydiseaseprogram.aspx
Department of Health’s HIV Client Services offers the Early Intervention Program for
eligible people with the Human Immunodeficiency Virus (HIV). The program may provide
financial help for prescription drugs.
Phone: 1-877-376-9316
Website: www.doh.wa.gov/YouandYourFamily/IllnessandDisease/HIVAIDS/HIV/
CareClientServices.aspx
Leukemia and Lymphoma Society offers information and resources.
Phone: 1-800-955-4572
Website: www.lls.org
5 Paying for prescription drugsLou Gehrig’s Disease is also known as Amyotrophic Lateral Sclerosis (ALS). Medicare covers
people with ALS even if you are under age 65. For rules and options, contact the Centers for
Medicare and Medicaid Services (CMS).
Phone: 1-800-MEDICARE (1-800-633-4227)
TTY: 1-877-486-2048
Website: www.medicare.gov
Lupus Foundation of America, Inc. offers information and resources.
Phone: 1-877-774-2992
Website: www.lupus.org
National Alliance on Mental Illness offers information and resources.
Phone: 206-783-4288
Website: www.namiwa.org
National Multiple Sclerosis Society offers information and resources.
Phone: 1-800-344-4867
Website: www.nationalMSsociety.org
National Organization of Rare Disorders (NORD) administers medication assistance
programs to help uninsured or under-insured people in securing life-saving or life-sustaining
medications. NORD also administers Early Access Programs for investigational new drugs
(INDs) under the Federal Drug Administration approved Treatment-IND programs.
Phone: 1-203-744-0100
Website: www.rarediseases.org/
National Travel Patient Center may provide travel assistance if your disease requires you to
travel for specific medication treatment or therapy.
Phone: 1-800-296-1217
Website: www.patienttravel.org
Tuberculosis care may be available if you do not have coverage. Contact your local health
department listed in the blue pages of your telephone book or on the Web
For diseases and disability programs not listed, call the Insurance Consumer Hotline at 1-800-562-
6900 and ask to speak with a SHIBA volunteer advisor. You can also check with your local health
department listed in the blue pages of your telephone book or search online.
Paying for prescription drugs 6Free or low-cost programs
Many pharmaceutical companies participate in discounted and free prescriptions programs.
Some may offer coupons or rebates for qualifying prescriptions. Each has its own eligibility
requirements. Check the pharmaceutical companies’ websites for more information.
BenefitsCheckUp®, a website sponsored by the National Council on Aging and many other
Washington agencies, provides free program contacts for over 1,450 brand name and
generic drugs.
Website: www.benefitscheckup.org
Enbrel offers payment help to qualified patients.
Phone: 1-888-436-2735
Website: www.enbrel.com/pay-for-ENBREL.jspx
Express Scripts through Rx Outreach may help people who qualify financially to obtain
medications through this program, even if they receive help through another discount program.
The program is available to individuals and families with incomes up to 250 percent of the
federal poverty level.
Phone: 1-800-769-3880
Website: www.rxoutreach.com
GlaxoSmith Kline Patient Assistance Programs offer help with medications.
Phone: 1-866-475-3678
Website: www.gskforyou.com
The Medicine Program, for a small fee, helps people apply for enrollment in one or more
patient assistance programs.
Website: www.freemedicineprogram.org
Merck Patient Assistance Program offers people prescription drug assistance whose
household income is at or below 400 percent of the federal poverty level.
Phone: 1-800-727-5400
Website: www.merck.com/merckhelps
Needy Meds Program can help you find patient assistance programs and applications for the
medications you take.
Website: www.needymeds.org
7 Paying for prescription drugsParentHelp 123 connects families with health resources and more.
Phone: 1-800-322-2588
Website: www.parenthelp123.org
Partnership for Prescription Assistance (PPARX) has access to more than 475 public and
private programs, including nearly 200 offered by pharmaceutical companies. in one free,
central site.
Phone: 1-888-477-2669
Website: www.pparx.org (Also available in Spanish.)
Pfizer Helpful Answers provides a list of patient assistance programs for people without
prescription drug coverage. Pfizer’s website offers a program finder tool to locate a prescription
drug program.
Phone: 1-866-706-2400
Website: www.pfizerhelpfulanswers.com
Rx Assist, Patient Assistance Program Center provides information about free and low-cost
medicine programs.
Website: www.rxassist.org
RX Hope provides access to government- and corporate-sponsored patient assistance programs
for over 1,000 medications.
Phone: 1-877-267-0517
Website: www.rxhope.com
Charity Programs
The following charity programs may help pay a portion of prescription drug costs for
consumers, including those enrolled in a Medicare Part D plan. Charity programs may take into
account your medical condition, income, cost of living, family size, and medical expenses.
Be the Match offered by the National Marrow Donor Program that connects patients and
families with support and advocacy services, and financial resources.
Phone: 1-888-999-6743
Website: www.bethematch.org
Caring Voice Coalition offers comprehensive help for patients with serious chronic illnesses.
They also have financial assistance programs available to pay for insurance premiums, co-
insurance, and Medicare prescription drugs.
Phone: 1-888-267-1440
Website: www.caringvoice.org
Paying for prescription drugs 8Chronic Disease Fund provides help to underinsured people diagnosed with chronic or life-
altering diseases that require the use of expensive, specialized therapeutics.
Phone: 1-877-968-7233
Website: www.cdfund.org
The HealthWell Foundation helps people afford prescription medications for specific illnesses.
Phone: 1-800-675-8416
Website: www.healthwellfoundation.org
Patient Advocate Foundation’s Co-Pay Relief (CPR) provides direct co-payment assistance
for pharmaceutical products to insured people who qualify financially and medically.
Phone: 1-866-512-3862, Option 1
Website: www.copays.org
Community social service agency programs
Some community social service agencies may offer limited or emergency help with prescriptions.
Check your local community action agency, such as St. Vincent de Paul, Salvation Army, etc.,
listed in the yellow pages of your telephone book or online.
Clinical drug trials
Many formularies do not pay for drugs they consider “experimental.” One way to get access
to new drugs free of charge is to enroll in a clinical trial. Phase I trials determine whether or
not the drug is safe. Phase II (small sample) and Phase III (large sample) trials determine the
effectiveness of the new drugs and gather further data on side effects. Check with your doctor
or a research hospital near you. Current clinical trials are listed by disease and trial location at
www.centerwatch.com or www.clinicaltrials.gov.
Comparison shopping
Prescription prices can vary widely from one pharmacy to another. Comparison shop your local
pharmacies for the lowest price. Many large retailers offer common generic drugs at a low cost.
Buying from Canada
While we do not advocate buying prescription drugs in Canada, we recognize that many U.S.
citizens purchase prescriptions in Canada, where they may cost less. Generally, this requires you
take your U.S. prescriptions to a Canadian doctor who rewrites them as Canadian prescriptions.
You then fill the prescriptions in Canada, and show your U.S. and Canadian prescriptions at the
border. Be aware that generics are not necessarily cheaper in Canada, and drugs sometimes have
different names than their U.S. equivalents.
9 Paying for prescription drugsNOTE: The U.S. Customs and Border Protection agency (www.customs.gov) and the U.S.
Federal Drug Administration (www.fda.gov) websites both state it’s technically illegal to import
drugs into the U.S.
However, the Federal Drug Administration (FDA) has developed “Coverage of Personal
Importation” guidance, which states that the agency’s current policy is to refrain from action
when the product:
• Is for the patient’s own use
• Is in amounts that don’t exceed a three-month supply
• Provides the name and address of the licensed provider responsible for the patient’s care
(This guidance could change. Please check the FDA website for the most current information.)
You can also access other important consumer drug information, such as warnings about buying
prescription drugs from other countries at: www.fda.gov/cder.
NOTE: The Medicare Modernization Act made several changes to U.S. law about prescription
importation. Keep current by checking the federal websites previously listed.
For more information, call:
U.S. Customs and Border Protection: 1-202-354-1000 or
U.S. Federal Drug Administration: 1-888-463-6332
Canadian Internet/mail order
The U. S. Customs and Border Protection Agency (U.S. Customs) reserves the right to detain
mail shipments for inspection. If they detain a package, U.S. Customs will send you a notice in
the mail to inform you of the detainment and your right to contest it. If you do not contest the
notice, U.S. Customs will not allow the shipment into the U.S.
Some Canadian mail-order plans will replace detained shipments.
Be aware that narcotics, controlled substances, insulin, and drugs requiring refrigeration are not
available by Canadian mail order.
Cautions for buying prescriptions online
Before you buy prescriptions online, check with the National Association of Boards of Pharmacy
(NABP). The NABP offers a list of websites it recommends you do not buy from at www.nabp.
net/programs/consumer-protection/buying-medicine-online/not-recommended-sites. NABP
reviewed nearly 10,500 websites and found that 97 percent of them do not comply with U.S.
pharmacy laws. NABP offers the following tips:
Paying for prescription drugs 10• Go to www.legitscript.com to verify online pharmacies are legitimate.
• Check out www.pharmahelper.com for search tools to compare online pharmacy drug
prices. Participating pharmacies must meet the National Association of Boards of
Pharmacy standards.
• Always obtain a prescription from your provider for any medications.
• Make sure the website requires a prescription and has a pharmacist available for
questions.
• Look for a seal of approval on the website, such as the Verified Internet Pharmacy
Practice Sites (VIPPS) or Vet-VIPPS accredited, which certifies the pharmacy is fully
licensed and complies with standards, such as protecting your medical information.
There are 59 sites currently representing more than 12,000 online pharmacies that have
received accreditation
• Make sure the Internet pharmacy lists its address and toll-free phone number as
required by law. Remember, FDA standards apply only in the U.S. If you order from
another country, make sure you know which quality standards apply. Visit www.fda.gov
to find out about FDA consumer alerts on importing prescriptions.
• If you have Medicare, check to see if the Internet pharmacy is enrolled in the Medicare
program. (Some U.S. Medigap plans will cover drugs you buy in Canada, and some will
not. Check with your insurer.)
• Find out if the online pharmacy protects your personal information, such as credit card
numbers.
Beware of scams regarding discount cards and Medicare. If you suspect or experience fraud
online, contact the Attorney General’s Consumer Hotline at 1-800-551-4636.
11 Paying for prescription drugsPaying for prescription drugs 12
Need more help?
Call our Insurance Consumer Hotline!
We enforce insurance law and can investigate
complaints against insurance companies and agents
on your behalf.
We also offer free, unbiased individual counseling
and group education on health care issues in your
communities. Our highly trained Statewide Health
Insurance Benefits Advisors (SHIBA) volunteers can
help you understand your rights and options about
health care coverage, prescription drugs, government
programs, long-term care options, and more.
1-800-562-6900
TDD: 1-360-586-0241
Or visit:
www.insurance.wa.gov
This publication may have been partially funded by grants from the Centers for
Medicare & Medicaid Services and the US Administration on Community Living.
SHP525FR-2051-SHIBA-Booklet-Paying for Prescription drugs-EN rev. 12/13You can also read
